Flare of palmoplantar psoriasis with ustekinumab.

Though there are countless reports of I de novo i and paradoxical worsening of palmoplantar pustular psoriasis (PPPP) and palmoplantar pustulosis (PPP) with TNF inhibitors,[1] these side effects are not well-recognised with ustekinumab. A 54-year-old male smoker with palmoplantar psoriasis consisting of erythema, scale and hyperkeratosis in the absence of pustules noticed a flare after the initial dose of ustekinumab. The pathophysiology of palmoplantar psoriasis, PPPP and PPP is thought to be different to chronic plaque-type psoriasis with different cytokines such as IL-36 and IL-17 playing a role. [Extracted from the article]